Comprehensive Approaches to Diagnosis and Treatment of Sensitive Skin

Abstract

Sensitive skin (SS) is increasingly recognized as a complex syndrome characterized by discomfort and heightened sensitivity to otherwise harmless stimuli, such as environmental changes, physical contact, and cosmetic products. This condition poses challenges in both diagnosis and treatment due to its variable presentation and subjective nature. The pathophysiological features of SS include neurogenic inflammation and small fiber neuropathy, largely driven by the hyperactivation of sensory nerves. This hyperactivation is closely associated with transient receptor potential (TRP) channels, particularly TRPV1, which contribute to the exaggerated sensory responses seen in SS. Furthermore, psychological factors like stress and anxiety, along with environmental stressors such as pollution and ultraviolet exposure, play significant roles in exacerbating symptoms. The diverse and individualized responses to stimuli make it difficult to establish standardized diagnostic criteria for SS, necessitating a combination of subjective diagnostic tools (e.g., the Sensitive Scale-10) and objective assessments (e.g., transepidermal water loss and lactic acid sting test) to accurately identify and assess SS. This paper provides a comprehensive review of SS, covering its definition, prevalence, pathogenesis, diagnostic challenges, and management strategies, and highlights the importance of personalized care in effectively managing SS and improving patient quality of life.

Keywords: Pathophysiology; Pruritus; Sensitive Scale-10; Sensitive skin; Skin diseases; Skin irritancy tests; Skin physiological phenomena.

Fig. 1. Schematic illustration of the pathophysiology of sensitive skin, including key mechanisms such as impaired barrier function, neurosensory dysregulation, inflammation, and genetic susceptibility.

GPCR: G protein-coupled receptor, TRP: transient receptor potential, KC: keratinocyte, DC: dendritic cell, NO: nitric oxide, ATP: adenosine triphosphate.

Fig. 2. The Sensitive Scale-10 (SS-10): a validated questionnaire developed by Misery et al. to quantify sensitive skin symptoms. It includes 10 items rated from 0–10, with a maximum score of 100.

Fig. 3. Proposed stepwise management algorithm for sensitive skin. Emphasizes trigger avoidance, barrier repair, subjective/objective assessment, and personalized pharmacologic strategies.

TEWL: transepidermal water loss, GABA: gamma-aminobutyric acid.